Discharge summaries: The key to improving physician communication, reducing readmissions

Traditionally, readmissions are considered a problem for hospitals because hospitals receive the brunt of the consequences in the form of financial penalties. Going forward, readmissions are going to be an issue for physicians more and more.

The major force behind this change is the Affordable Care Act, according to Ann Whitehead, the vice president of risk management and patient safety of the Cooperative of American Physicians’ CAPAssurance program.

"Healthcare reform is not just about reducing costs, it's about closing gaps in communication among health care providers leading to improved quality, safe discharges and decreased readmissions," says Ms. Whitehead. "Hospitals are faced with the challenge of getting active participation from physicians and staff in identifying the specific problems associated with an inadequate discharge process."

A major factor that contributes to readmissions is physician communication. Good communication among and between hospitalists, primary care physicians and patients during the discharge period is pivotal to boosting patient safety and reducing the likelihood of an unplanned trip back to the hospital.

Unfortunately, this communication happens less than it should.

One study published in the Journal of Hospital Medicine revealed direct communication from hospitalists to primary care physicians occurred only 3 to 20 percent of the time at discharge.

Although direct communication via face-to-face interaction or phone call is ideal, it is not always possible considering how full most physicians' schedules are. That's where discharge summaries come in.

Discharge summaries provide a means for hospitalists to communicate with both patients and primary care physicians. The problem is, discharge summaries are really only conducive to moving information and responsibility in one direction — from the hospitalist to the patients and primary care physicians.

Also, discharge summaries are only helpful when they are filled out in their entirety and in a timely fashion, which is not always the case.

Research published in the Annals of Internal Medicine found less than one third (12 to 33 percent) of primary care physicians involved in the study were able to access their patient's discharge summaries at the time of the patient's first post-discharge visit. This failure in communication could mean leaving primary care physicians unaware of a patient's diagnosis, potentially actionable test results, reconciled discharge medications, required follow-up care and confirmed or pending test or procedure results.

That said, breaking down the communication silos between hospitalists and primary care physicians, and improving how they use discharge summaries is a must, according to Ms. Whitehead.

"Risk management and patient safety providers are in a unique position to influence, change and reduce adverse events, readmissions and potential liability by providing education and support for discharge plan development. This starts with fostering a culture of teamwork and a mindset of 'teamwork and cooperation,'" says Ms. Whitehead. "This will result in a more comprehensive discharge process and transition of care."

In addition to enhancing communication among physicians, improving communication between physicians and patients is also important. There are new mobile applications and technological tools that have been created to this end, but Ms. Whitehead suggests some of the smallest changes are the ones that can have the greatest impact on patients.

Many adults in the U.S. read below a 5th grade level, so if a physician tells patients to cut "salt" from their diet instead of "sodium," it can make a big difference in the level of comprehension. Also, having physicians ask patients to repeat care instructions back to them can boost understanding between to two parties.

Ultimately, preventing readmissions all goes back to communication around the discharge process.

"It is important for healthcare providers to implement high reliability systems that improve discharge communication and the transitions of care, and enhance communication between the hospitalist and primary care physician," says Ms. Whitehead. "This small step will help to limit unnecessary readmissions, improve quality and decrease adverse events."



More articles on readmissions:
California pilot project aims to cut cardiac readmissions with preemptive house calls
52 hospitals with the lowest all-cause unplanned readmission rates
Patient safety tool: 2 resources on reducing readmissions from the Joint Commission

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